HomeMy WebLinkAbout2729 Declaration of Domicile and Citizenship
"I~O THE STATf: ANU ('OUNTY TA1i ASSk:SSOR. 24'7636
~ _ _ _ CUUNTY, FLORIUA: ;
Tl~is is my d~cl.iraliun o1~ U~micile and C'itizenship in thc Statr of Florida that 1 am tiling this day in ~
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accorJ:~nrc, :uid in contormity with Section l 7. Fiorida Statut~s. j
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1 was formerly a lrgal msidcnt of _ ~~C-~~_ L~! and I
t(' tY) lSlate) i
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nn.7drd at . _ _ ~_~!t/_ . However. 1 have changed my domicile to
(Strret anJ Humbrr)
a~~d have becn a bona iide residcnt of the State ot Florida since day ~ot {
___G!~ - . 19_(~ 3_. and I rrsiar at
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7 _
(Street and Numbrr)
_ - 1~~~~ - - • County. Florida,
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and this statem. nt is to be takrn as my d~rlaration of ~iti-r.ensliip, actual tegal residence and domicile in the State
of Florida.
(lnsrr~ hrre -rny perlinrnt facts, such as sale uf ptuprrly or bu~inrss, c~r relinyuichment of rmplo)'mrnt at tormrr
domicile, rrmoval ut famih• to ne.~ Jumicile, purehrse of humr, rtcJ
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~L2~~ ~J ~ ~(/`u ST_LUCIr C~UNTY flA-
~^.l/`'' li`'~ ~7 R?"vF - ~ JljA~S ~
~ CLE+ K Li. G~~l COURT
P.fC^ri 1E~ =~c~
FEe 11 9 4o aM'73
24'~636
1 FURTHER CERTIFY th:it 1~vill rrgistrr at my loral address whrn ttte rr~istration books reopen, and
comply with all othrr requiremrnt~ ~f a icgal rr~id~nt ot~ this Statr.
1 FUR NF,R CE T[FY that I i~avc no intrntion to return to my forn~er d nirile, and ! intend to remain in
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Florida, permanently. ~
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(Name) - - - - - -
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(Address)
Sworn to,~~e~d subsrribed before me this ~1a~~ of
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1 ota~ PuBic State uf 1 lu a at lar~c ~~/1
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ti~%~C'.bm1~?i'ss~on'~-~?~cs~ - ~`n' .
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j,,~ `~~q~e e~rcutrd ~n Jup6rate anJ nri~in~t flyd .cith ('Ierk ('ircuit Courl. anJ dupli~rtr with Tax Assessor)
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